The term shin splints refers to nonspecific pain that occurs in the lower legs during running sports.
Repetitive impact forces during jogging, running, or vigorous walking (eg, hiking) can overload the musculotendinous unit and cause shin pain. Such pain sometimes results from a specific injury (eg, tibial stress fracture, exercise-induced compartment syndrome, tibial periostitis, excessive foot pronation), but often an exact cause cannot be identified (1). In such cases, the term shin splints is used. Shin splints are fairly common, but severe pain not responding to rest or associated with tissue swelling or distal discoloration warrants prompt specialist evaluation.
General reference
1. Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012;31(2):273-290. doi:10.1016/j.csm.2011.09.008
Symptoms and Signs of Shin Splints
Pain can occur in the anterior or posterior aspect of the leg and typically begins at the start of activity but then lessens as activity continues. Pain that persists during rest suggests another cause, such as stress fracture of the tibia.
Diagnosis of Shin Splints
History and physical examination alone
Patients report diffuse tenderness along the posteromedial surface of the distal tibia during exercise (1). On examination, severe localized tenderness is usually present over the anterior compartment muscles, and sometimes there is palpable bone pain.
Radiographic findings are usually unremarkable, regardless of the cause. If a stress fracture is suspected, an MRI or bone scan may be necessary.
Although less common, exercise-induced compartment syndrome is sometimes difficult to distinguish from shin splints because both conditions present with exertional leg pain. Diagnosis of exercise-induced compartment syndrome requires specialized testing to measure static and dynamic intramuscular compartment pressures. Rarely, continued exercise-induced compartment syndrome can develop into acute compartment syndrome.
Diagnosis reference
1. Wilder RP, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 2004;23(1):55-vi. doi:10.1016/S0278-5919(03)00085-1
Treatment of Shin Splints
Modification of activity
Stretches, nonsteroidal anti-inflammatory drugs (NSAIDs)
Running must be stopped until it causes no pain. Early treatment is ice, NSAIDs, and stretching of the anterior and posterior calf muscles. During the rest phase of treatment, deconditioning can be minimized by encouraging cross-training techniques that do not require repetitive weight-bearing activity, such as swimming.
Once symptoms have resolved, it is advised that a return to running be gradual. Wearing supportive shoes with rigid heel counters and arch supports helps support the foot and ankle during running and can aid recovery and prevent further symptoms. Avoiding running on hard surfaces (eg, cement roads) can also help. Exercising the front of the calves by dorsiflexing the ankle against resistance (eg, rubber bands or a dorsiflexion machine) increases leg muscle strength and can help prevent shin pain.
1. Stand with both feet on step with heels off edge of step. Hold on for support.
2. Raise up on balls of feet.
3. Focu
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on balls of feet with heels off the floor.
2. Walk on balls of feet while keeping knees straight.
3. Walk as f
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on heels with balls of feet off the floor.
2. Walk on heels while keeping knees straight.
3. Walk as far as ab
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep heels on t
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep rear leg s
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Sit in chair.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing d
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall.
2. Bend knee on involved side to place top of involved foot dow
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand with both feet on step with heels off edge of step. Hold on for support.
2. Raise up on balls of feet.
3. Focus on slowly lowering heels to below the height of the step.
4. Return to starting position and repeat.
5. Perform 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on balls of feet with heels off the floor.
2. Walk on balls of feet while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Perform 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on heels with balls of feet off the floor.
2. Walk on heels while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Perform 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep heels on the floor and slowly bend both knees to feel stretch along the calf of the rear leg.
4. Hold exercise for 30 seconds.
5. Perform 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep rear leg straight with knees and toes pointing toward the wall, keep rear heel on the floor.
4. Bend knee on uninvolved leg and lean hips toward the wall to feel a stretch along the calf of the rear leg.
5. Hold exercise for 30 seconds.
6. Perform 1 set of 4 repetitions, 3 times a day.
(It is important to maintain a straight back posture with the heel firmly planted [not lifted] during the stretch.)
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Sit in chair.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing down.
3. Slowly sit forward in the chair and push foot into plantarflexion until a stretch is felt over the top of the foot and ankle.
4. Hold exercise for 30 seconds.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Special Instructions
a. Perform plantarflexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing down.
3. Bend knee on uninvolved side and slowly lower body until stretch is felt over the top of the foot and ankle.
4. Hold exercise for 30 second.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Special Instructions
a. Perform plantarflexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
